Can the Use of a Lumbar Puncture Cradle Increase Lumbar Puncture (LP) Success Rates?
Peer Reviewed Published Paper Regarding
SMöLTAP from the University of Toronto
Background
- Lumbar puncture (LP) success rates are low (50-80%), while traumatic taps occur in 30-50%
- Missed LPs have multiple implications for patients & the healthcare system
- The seated position has been shown in some studies to increase LP success rates
Aims
- To evaluate the use of a LP cradle on first-pass success rates on neonatal and infant LPs compared to lateral decubitus (primary)
- Secondary aims were to compare overall LP success rate for >1 attempt and traumatic LP rates with and without the cradle
The use of our lumbar puncture cradle, compared to the lateral decubitus method, resulted in:
An absolute increase of 22% of first-pass lumbar puncture success (63% vs 41%)
An absolute decrease of 23% of traumatic lumbar punctures (36% vs 59%)
The Results
PRIMARY OUTCOME
| Cradle | Lateral Decubitus | Difference (95% CI) | |
| First-pass success | 45/71 (63%) | 29/71 (41%) | 22% (5.6-36.8) |
χ2 (1, 142) = 7.22, p=0.007
SECONDARY OUTCOME
| Cradle | Lateral Decubitus | Difference (95% CI) | |
| Overall success rate | 51/71 (80%) | 50/71 (70%) | 10% (-4.3-23.8) |
| Traumatic puncture rate ( > 400 RBCs/uL “Bloody”) | 25/69 (63%) | 41/70 (59%) | 23% (6.6-37.8) |
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